Provider Demographics
NPI:1831330612
Name:COOK, DANA SMITH (MSSW, LCSW)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:SMITH
Last Name:COOK
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50905
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-4205
Mailing Address - Country:US
Mailing Address - Phone:270-782-3583
Mailing Address - Fax:270-782-9876
Practice Address - Street 1:3255 SPRING HOLLOW AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4486
Practice Address - Country:US
Practice Address - Phone:270-782-3583
Practice Address - Fax:270-782-9876
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical